<%@taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@taglib uri="http://www.springframework.org/tags/form" prefix="form" %>
<!doctype html>
<html lang="en">
<head>
<title>Welcome to Forte Oil Loyalty System - Powered by PointMi</title>
<%@ include file="head.jsp" %>
</head>

    <body>
    	<div class="container-fluid">
<div class="row-fluid">  
<form:errors path="*" cssClass="alert-error" element="div"/> 
    <input type="text" disabled="disabled" value="010229922" class="span10"  />
  <div id="authbody">
  <form:form>
             <div class="brand"><a href="/"><img src="img/fortelogo.png" /></a></div>
             <div class="discover"><h1>Welcome to Forte Oil Loyalty Point System</h1><h5>Powered by PointMi Services</h5></div>               <form:form action="signup.do" method="post" commandName="customer">
             <div class="authmain">
				
               <div class="authsocial"> 
                  <input type="text" disabled="disabled" value="010229922" class="span10"  />
                  <form:input cssClass="span10" required="required" placeholder="Email" title="Email" path="email" /> 
                  <form:input path="firstName" required="required" title="First Name" placeholder="First Name" cssClass="span10" />
                  <form:input path="lastname" required="required" title="Last Name" placeholder="Last Name" cssClass="span10" />                    
             </div>
                  <div class="authmanual">
                  <form:input title="Contact Address" required="required" path="address" id="address" placeholder="Contact Address" cssClass="span10"></form:input>  
                           <form:input required="required" title="Mobile Phone" path="phone" id="phone" placeholder="Mobile Phone" cssClass="span10"></form:input>
                             <form:input path="city" placeholder="City" cssClass="span10"></form:input>   
                            <form:select cssClass="span10" path="state">
                              <option>Select State</option>
                              <option value="Abia">Abia</option>
                              <option value="Abuja Federal Capital">Abuja Federal Capital</option>
                              <option value="Adamawa">Adamawa</option>
                              <option value="Akwa Ibom">Akwa Ibom</option>
                              <option value="Anambra">Anambra</option>
                              <option value="Bauchi">Bauchi</option>
                              <option value="Bayelsa">Bayelsa</option>
                              <option value="Benue">Benue</option>
                              <option value="Borno">Borno</option>
                              <option value="Cross River">Cross River</option>
                              <option value="Delta">Delta</option>
                              <option value="Ebonyi">Ebonyi</option>
                              <option value="Edo">Edo</option>
                              <option value="Ekiti">Ekiti</option>
                              <option value="Enugu">Enugu</option>
                              <option value="Gombe">Gombe</option>
                              <option value="Imo">Imo</option>
                              <option value="Jigawa">Jigawa</option>
                              <option value="Kaduna">Kaduna</option>
                              <option value="Kano">Kano</option>
                              <option value="Katsina">Katsina</option>
                              <option value="Kebbi">Kebbi</option>
                              <option value="Kogi">Kogi</option>
                              <option value="Kwara">Kwara</option>
                              <option value="Lagos">Lagos</option>
                              <option value="Nassarawa">Nassarawa</option>
                              <option value="Niger">Niger</option>
                              <option value="Ogun">Ogun</option>
                              <option value="Ondo">Ondo</option>
                              <option value="Osun">Osun</option>
                              <option value="Oyo">Oyo</option>
                              <option value="Plateau">Plateau</option>
                              <option value="Rivers">Rivers</option>
                              <option value="Sokoto">Sokoto</option>
                              <option value="Taraba">Taraba</option>
                              <option value="Yobe">Yobe</option>
                              <option value="Zamfara">Zamfara</option>
</form:select>
                             
             </div>
             </div>
               <div class="authsubmit">
              <h5>Already have an account? <a href="login.do">Log in</a>. By clicking signup, you agree to our <a href="#">Terms of Use</a>.</h5>
              <button type="submit"  class="btn btn-success">Submit</button>
              </div>
              </form:form>
             </div>
      </div>
  </div>
    </body>
    <%@ include file="js.jsp" %>
</html>
